Urinary pH In Patients Research Articles

Relationship Between HDL and Urine pH in Patients with Urinary Tract Stones

Decreased HDL levels are one of diagnosis component of dyslipidemia which is part of the metabolic syndrome. when HDL levels decrease, its role as an anti-atherosclerotic can affect insulin resistance and it can eventually lower urine pH and potentially can cause urinary tract stones formation. The objective of this study is to determine the correlation between HDL Levels and Urine pH in Patients with Urinary Stones. A hospital based cross-sectional study included 52 patients with Urinary Stone who attended urology outpatient clinic in dr. M. Soewandhie General Hospital Surabaya during April-June 2022. HDL levels and Urine pH were recorded. The correlation between HDL levels and urine pH were tested using Spearman’s test. Mean of HDL levels were 44,96±9,109 mg/dL, and urine pH was 5,7692±0,70336. HDL levels was positively correlated with urine pH (r=0,336, p=0,015). There is a significant correlation between HDL levels and urine pH in patients with urinary stones. This is line with the fact that if HDL levels decrease, the urine pH will also decrease due to the influence of insulin resistance on the metabolic syndrome in patients with urinary tract stones.

Urinary pH: its regulation and relevance in urolithiasis metaphylaxis

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence.

A rise in saliva and urine pH in children with SCN1A-related epilepsy: An exploratory prospective controlled study.

ObjectiveSCN1A, encoding the alpha 1 subunit of the sodium channel, is associated with a range of related epilepsy. This study aims to assess saliva and urine pH in children with SCN1A-related epilepsy.MethodsA prospective controlled observational study with a 1:1 ratio was conducted on seven patients with SCN1A-related epilepsy and seven healthy children of the same family, gender, and age but without a history of seizures. The pH of saliva and urine was measured by pH test paper. Parents of patients with epilepsy recorded seizures to compare the relationship between pH and seizures.ResultsThe fourteen participants were all males, aged 1 to 14 years. Seven patients had different pathogenic SCN1A variants. The pH of saliva and urine was monitored for 21–95 days. The pH of saliva and urine was higher in patients with SCN1A-related epilepsy than in the healthy group. The urine pH in Dravet syndrome patients was high compared with other epilepsy patients. The urine pH in patients with seizures was higher than that in patients without seizures, which occurred during the study.ConclusionsThe pH of saliva and urine was chronically high in patients with SCN1A-related epilepsy, and urine pH was higher in patients with seizures and with Dravet syndrome.

Occult Renal Calcifications in Patients with Normocalcemic Primary Hyperparathyroidism and Their Association with the Parathyroid Hormone-Vitamin D Axis.

Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevated serum levels of parathyroid hormone (PTH) with persistently normal serum calcium concentrations after excluding secondary causes of hyperparathyroidism. Urolithiasis and/or nephrocalcinosis may occur in hypercalcemic PHPT, but little is known about these complications in NPHPT. Objectives. To identify occult urolithiasis and nephrocalcinosis in asymptomatic patients with NPHPT and evaluate biochemical markers as risk predictors for the development of renal calcification (RC). Methods. Cross-sectional analysis of 34 patients with no history of urolithiasis and/or nephrocalcinosis. The diagnosis of NPHPT was as follows: elevated serum PTH (reference range: 15–65 pg/mL), normal albumin-corrected serum calcium, normal urinary calcium excretion, serum 25(OH)D >30 ng/mL, eGFR (CKD-EPI) > 60 mL/min/1.73 m2, without intestinal disease, and not on medications such as thiazide diuretics, lithium, bisphosphonates, or denosumab. Patients were categorized according to the presence or absence of RC identified by renal imaging. Their clinical and biochemical characteristics were then compared. Results. The patients had a mean age of 67.97 ± 10.45 years, predominantly postmenopausal women (88.2%); serum PTH, 119.67 ± 64.44 pg/mL; 25(OH)D, 39.00 ± 8.88 ng/dL; 1.25(OH))2D, 74.53 ± 26.37 pg/mL; corrected serum calcium, 9.34 ± 0.62 mg/dL; and 24-hour urinary calcium, 134.87 ± 79.68 mg/day. RC was identified in 26.5% of the patients. There was no difference in anthropometric and clinical parameters, renal function, 25(OH)D, and urinary pH in patients with or without RC. Patients with RC had higher PTH values (176.22 vs. 99.32 pg/mL, P = 0.001), 1.25(OH) 2D (96.83 vs. 62.36 pg/mL, P = 0.005), and 24-hour urinary calcium (181.9 vs. 117.94 mg/day, P = 0.037). Conclusion. Occult renal calcifications are common in NPHPT and are associated with increased serum PTH, 1.25(OH))2D, and 24 h urinary calcium.

Randomized Clinical Study, Comparative of Parallel Groups, to Evaluate the Effectiveness of Three Preparations of Potassium Citrate in Producing an Increase in Urinary pH in Patients with a History of Kidney Stones

Background: A very strict control of urinary pH is recommended to maintain it between 5.5 and 6.2, preventing formation or recurrence of crystals. Kidney stones are a common problem, with a high rate of recurrence, not altered by the success of surgery. Medical treatment prevents recurrence. Potassium Citrate inhibits crystallization of calcium salts. It influences calculogenesis by increasing urinary citrates and alkalinizing the urine. Purpose: to evaluate the similarity in the effect of three K citrate products, K citrate reference product Urocit® 10 mEq, and K citrate from Laboratorios LETI S.A.V., 10 mEq and 15 mEq, on urinary pH. Materials and Methods: We carried out a prospective, randomized study of three parallel groups. We admitted female and male patients with history of kidney stones or evidence of lithiasis (grit, microlithiasis) in the renal echosonogram. Laboratory assessments: urine, 24-hour urine, urinary pH, Calcium, uric acid, Phosphorus, Sodium, protein and urinary creatinine at times: start, day 7, day 21, 30 of treatment. Results: all three products produced a slight increase in urinary pH in the simple urine test and 24-hour urine, with no differences between groups or their logarithmically transformed means and their CI95, which did not exceed the range between 80% and 125%. Conclusions: K Citrate, 10 mEq and 7.5 mEq, from Laboratorios LETI, S.A.V., at a dose of 30 mEq daily in patients with history of kidney stones are equivalent to the reference product Urocit®, in its effects on urinary pH in 24-hour urine, and in the simple urine test.

Introduction of a Standardized Approach of Electronic Urinary pH Monitoring to Assist Alkalization Therapy: A Uric Acid Urolithiasis Patient's Perspective.

Introduction: This study evaluates the introduction of an electronic pH meter to measure the urinary pH in patients with uric acid (UA) urolithiasis and assess patient's perspective. Materials and Methods: Patients known with UA urolithiasis were included in this single-center, nonrandomized, prospective feasibility study, IDEAL stage 2a. Their experience with urolithiasis and satisfaction with the method of urinary pH monitoring before inclusion was evaluated. All patients received an electronic pH meter and standardized instructions. After a period of 6-12 weeks their experience and satisfaction with this pH meter and new regimen was assessed. Patient satisfaction was scored on a Likert scale 1-5. Results: Eighteen patients were included. Median age was 63 years and median body mass index was 30 kg/m2. The cohort consisted of 67% men and 33% women. In their medical history, 55% had unilateral stones, whereas 45% had bilateral stones. The median estimated glomerular filtration rate was 58 mL/minute/1.73 m2. Eighty-nine percent took medication to alkalize their urine, median 3.5 years. Fifteen patients used paper reagent strips and three used an electronic pH meter to assess urinary pH before this study. Satisfaction with the method of urinary pH measurement at inclusion was reasonable (median score 3; interquartile range [IQR] 1-4). Satisfaction with the new electronic pH meter was good (median score 4; IQR 3-5), as was the overall satisfaction (median score 4; IQR 3-5). The new electronic pH meter was slightly easier to use (median 3.5; IQR 1.75-5), as easy in maintenance (median 3; IQR 2-4), and significantly easier to read (median 5; IQR 4-5). The new electronic pH meter was better (median score 4; IQR 2.75-5) than their previous method. Conclusion: The introduction of a standardized approach of urinary pH monitoring for UA urolithiasis patients with an electronic pH meter leads to an easier interpretable outcome and higher patient satisfaction.

Urine pH Value and Bacteriology in Purple Urine Bag Syndrome

Background: Purple urine bag syndrome (PUBS) is an unusual phenomenon in patients with urinary tract infections. The urine of most of these patients has an alkaline pH. Objective: The goal of this study was to identify infectious bacteria and determine urinary pH in patients with PUBS and to evaluate their correlation. Methods: PubMed was searched using the term “Purple urine bag syndrome (PUBS)” for studies on this condition published from October 1980 to September 2019. Sixty-seven patients were identified and divided into those with urine cultures positive for Gram-positive bacteria (GPB; n = 3), Gram-negative bacteria (GNB; n = 45), and mixed Gram-positive and Gram-negative bacteria (MGPNB; n = 19). Age, gender, urinary pH, comorbidities (diabetes and uremia), fever, shock, and mortality were compared in the 3 groups. The correlation between urinary pH and type of bacteria in urine cultures was assessed by regression analysis. Results: Presentation of fever in PUBS accounted for 66.7, 11.1, and 5.3%, p < 0.05, in GPB, GNB, and MGPNB. Regression analyses showed that Pseudomonas aeruginosa was associated with less alkaline urine (regression coefficient −0.936, p < 0.05), whereas Proteus spp. was associated with more alkaline urine (regression coefficient 0.489, p = 0.04). GNB were the most predominant pathogens in patients with PUBS. Conclusion: In PUBS, urine pH and symptom presentation are different by variable bacteria. Fever is associated with urinary GPB. Proteus spp. correlates with more alkaline urine, whereas Pseudomonas spp. correlates significantly with less alkaline urine.

Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial

BackgroundEncrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks.MethodsA double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 – none; 3 – global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events.ResultsThe intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups.ConclusionsOur data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation.Trial registrationThis trial was registered at www.clinicaltrials.gov under the name “Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent” with date 2nd November 2017, code NCT03343275, and URL.

A different perspective: Can urine pH be important in the diagnosis of prostate cancer?

The aim of our study was to investigate emphasis of urinary pH in patients with prostate cancer. Patients, who underwent 12-core prostate biopsy because of prostate-specific antigen elevation and suspicious digital rectal examination, were retrospectively reviewed. According to pathology, patients with prostate cancer were classified as group 1, and patients with benign prostatic hyperplasia were classified as group 2. Primary endpoint of this study was the urine pH. The age of two groups and urine pH were compared with each other. Student t test and Mann-Whitney U test were used for the intergroup analysis of continuous variables. A cut-off value for urine pH was determined with a receiver operating characteristic curve. p < 0.05 was considered as statistically significant. There were 119 patients in group 1 and 99 patients in group 2. When urine pHs of both groups were compared, group 1 and group 2 were 5.1 ± 0.45 and 5.5 ± 0.79, respectively (p = 0.0001). The cut-off value determined by receiver operating characteristic curve analysis for urine pH was 5.2 (sensitivity: 42%, specificity: 79%, area under the curve: 0.61; 95% CI: [0.53, 0.68]; p = 0.003). Acidic urine pH may be important for predicting prostate cancer according to this study.

SPOT-TESTING URINE PH, A NOVEL BIOMARKER FOR PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Low urinary pH (UpH) is related to metabolic syndrome and chronic kidney disease, but few studies were performed to evaluate the value of UpH in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Patients with STEMI

Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine?

To study the effect of ascorbic acid (AA) supplementation on urinary pH, metabolic stone workup parameters, and development of de novo urolithiasis in stone-forming patients. A retrospective review of the patients followed-up at a tertiary stone centre between September 2009 and October 2015 was performed. Patients with recurrent urolithiasis who received AA supplementation as a urinary acidifying agent were included in the study. Detailed metabolic stone work-up, including two 24-hour urine collections obtained pre- and post-AA supplementation were compared. In addition, imaging studies were reviewed to assess the development of de novo urolithiasis. Twenty-four patients were included in the study with a mean age of 60.6 years and a median daily AA dose of 1000 mg (range: 500-2000 mg). Median follow-up period was 22.6 months (range: 19.7-32.1). After AA supplementation, there was a significant decrease in urinary pH (7.6 vs. 6.9, p=0.02). Although there was no significant increase in the daily oxalate excretion, two patients (8.3%) had their AA dose reduced or discontinued due to de novo hyperoxaluria (342.9 vs 510.2 umol/day; p=0.75). Other serum and urinary parameters did not show any significant changes. Eight (33.3%) patients developed de novo urolithiasis with struvite and carbonate apatite being the major components. AA supplementation resulted in significantly lower urinary pH in patients with recurrent urolithiasis and alkaline urine pH. Prospective studies are needed to assess whether this reduction in urinary pH is associated with lower stone recurrence rates.

MP01-20 SHOCKWAVE LITHOTRIPSY IMPAIRS URINE PH: RESULTS OF THE PROSPECTIVE SWISS KIDNEY STONE COHORT REGISTER

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2017MP01-20 SHOCKWAVE LITHOTRIPSY IMPAIRS URINE PH: RESULTS OF THE PROSPECTIVE SWISS KIDNEY STONE COHORT REGISTER Veronika Skuginna, Nilufar Mohebbi, Daniel Fuster, Min-Jeong Kim, Carsten A. Wagner, Grégoire Wuerzner, Nasser Dhayat, Olivier Bonny, and Beat Roth Veronika SkuginnaVeronika Skuginna More articles by this author , Nilufar MohebbiNilufar Mohebbi More articles by this author , Daniel FusterDaniel Fuster More articles by this author , Min-Jeong KimMin-Jeong Kim More articles by this author , Carsten A. WagnerCarsten A. Wagner More articles by this author , Grégoire WuerznerGrégoire Wuerzner More articles by this author , Nasser DhayatNasser Dhayat More articles by this author , Olivier BonnyOlivier Bonny More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.095AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urolithiasis is a global health problem with a lifetime risk of up to 15 % in white men and 6 % in women and a recurrence rate of about 50 % in these patients. Over the last three decades (and since the introduction of shock wave lithotripsy [SWL]) there was a change in stone composition observable with an increasing prevalence of calcium phosphate stones. Calcium phosphate crystallization is driven by urinary calcium phosphate supersaturation which rises with elevated urine pH. A recent animal study revealed an increase in urine pH of SWL treated porcine kidneys. We therefore evaluated the effect of SWL on urine pH in the Swiss Kidney Stone Cohort (SKSC), a nationwide, multicenter, prospective register of kidney stone patients. METHODS Of the first 350 patients enrolled in the SKSC register, 170 patients were eligible; 180 patients had to be excluded because of a short follow-up of <6 months, uric acid stone composition and/or incomplete data on previous stone treatment. The patients were grouped into 3 different groups according to their previous treatment: group A: SWL (n=49), group B: endourological treatment (n=67), group C: spontaneous stone passage (control group; n=54). The paired t-test and one-way ANOVA was used to compare the change of urine pH over time within and between the 3 different groups. RESULTS 44/170 (26%) patients were female. Median patient age was 47 years (range: 20-86). Stone composition was available in 57% of patients and did not significantly differ between the three groups (p=0.8). The median urine pH at first visit (≥ 4 weeks post stone passage or intervention) was slightly higher in group A after SWL as compared to the other two groups: pH 5.7 (IQR: 5.1-6.0) in group A; pH 5.5 (IQR: 5.0 -5.9) in group B; pH 5.5 (IQR: 5.1-6.0) in group C; p=0.4. There was a significant rise in urine pH at follow-up visit (3-6 months after initial visit) in group A after SWL treatment whereas no significant change was seen in the non-SWL groups B and C (median pH difference in groups A, B and C: +0.25, -0.19 and -0.005, respectively; p<0.001). CONCLUSIONS There was an increase in urine pH in patients who had undergone SWL while this was not seen in urinary stone patients who were treated endourologically or conservatively. This suggests that SWL may cause tubule cell injury that leads to functional disturbances such as changes of urine pH. Whether this has an impact on the rate of recurrences or future stone composition (increase in calcium phosphate content) will be explored in the further follow-up of these patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e9 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Veronika Skuginna More articles by this author Nilufar Mohebbi More articles by this author Daniel Fuster More articles by this author Min-Jeong Kim More articles by this author Carsten A. Wagner More articles by this author Grégoire Wuerzner More articles by this author Nasser Dhayat More articles by this author Olivier Bonny More articles by this author Beat Roth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary pH reflects dietary acid load in patients with type 2 diabetes.

Dietary acid load is important information, however, survey of food intake needs time and skill. Therefore, it is difficult to survey food intake from all patients. It remains to be elucidated the association between dietary acid load and urinary pH in patients with type 2 diabetes. In this cross-sectional study of 173 patients, we investigated the relationship between urinary pH and dietary acid load, assessed with potential renal acid load. Habitual food and nutrient intake was assessed by a self-administered diet history questionnaire. Urinary pH was negatively correlated with potential renal acid load (r = –0.24, p = 0.002). Multivariate regression analysis revealed that potential renal acid load (standardized regression coefficient = –0.21, p = 0.036) was associated with urinary pH after adjusting for covariates. In addition, according to the receiver operator characteristic analysis, the optimal cut-off point of urinary pH for high dietary acid load, defined as potential renal acid load over 7.0 mEq/day was 5.7 (area under the receiver operator characteristic curve 0.63 (95% CI 0.54–0.71), sensitivity = 0.56, specificity = 0.70, p = 0.004). Urinary pH was associated with dietary acid load in patients with type 2 diabetes. We suggest that urinary pH can be a practical screening marker for dietary acid load in patients with type 2 diabetes.

MP2-08 URINARY PH IS HIGHLY ASSOCIATED WITH BLADDER RECURRENCE AFTER NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS WITH POSITIVE SMOKING HISTORY

You have accessJournal of UrologyBladder Cancer: Upper Tract TCC I1 Apr 2015MP2-08 URINARY PH IS HIGHLY ASSOCIATED WITH BLADDER RECURRENCE AFTER NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS WITH POSITIVE SMOKING HISTORY Hiroki Ide, Eiji Kikuchi, Nobuyuki Tanaka, Akira Miyajima, and Mototsugu Oya Hiroki IdeHiroki Ide More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, it has been reported that the past history of smoking is a risk factor of bladder recurrence after surgery in upper urinary tract urothelial carcinoma (UTUC). Furthermore, it has been shown that lower urinary pH is significantly associated with bladder carcinogenesis, especially in smokers because acid urine activates aromatic amines derived from cigarette such as 4-aminobiphenyl and its N-hydroxy metabolite. However, to our knowledge, there has been no report about the association between urinary pH and bladder recurrence after surgery in UTUC patients. In the present study, we evaluated the predictors of bladder recurrence including urinary pH in patients with UTUC after surgery. METHODS A total of 168 UTUC patients without the history of bladder cancer who were surgically treated at our institution between 1990 and 2011 were included in the study. The mean follow-up period was 33 months. Urinary pH was defined as median of 3 consecutive data after surgery. Bladder recurrence-free survival (BRFS) was calculated by the Kaplan-Meir method. We used the Cox proportional hazards regression analysis to assess the independent predictors for BRFS. RESULTS Urinary pH was 5.00 to 5.49, 5.50 to 5.99, 6.00 to 6.49, 6.50 to 6.99 and 7.00 or more in 70, 47, 34, 11, and 6 patients, respectively. During follow-up period, bladder recurrence developed in 73 patients (40.6%) in overall. Furthermore, bladder recurrence rate is 57.1% in patients with pH less than 5.5, compared to 33.7% in those with pH 5.5 or more (p=0.002). Lower urinary pH (<5.5), gender, lymphovascular invasion and grade were all determined to be significant predictors of the BRFS based on a univariate analysis. A multivariate analysis revealed the lower urinary pH (p=0.006, hazard ratio 1.914) to be an independent prognostic factor for the BRFS. The 2-year and 5-year BRFS rates were 67.1 and 36.6 % for patients with pH less than 5.5 compared to 80.1 and 65.3 % for patients with pH 5.5 or more. Furthermore, focusing on patients with smoking history, BRFS in patients with pH less than 5.5 was significantly lower than it in those with pH 5.5 or more. Meanwhile, in patients without smoking history, there was no significant difference between lower and higher urinary pH groups. CONCLUSIONS Results suggest that urinary pH less than 5.5 increases the risk of bladder recurrence in UTUC patients after surgery, especially with smoking history. Modifying pH for urine alkalization might improve bladder recurrence rate after surgery in UTUC patients with smoking history. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e13 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroki Ide More articles by this author Eiji Kikuchi More articles by this author Nobuyuki Tanaka More articles by this author Akira Miyajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Analysis of risk factors in elderly patients with purple urine bag syndrome: A retrospective analysis in a medical center in northern Taiwan

Background: Purple urine bag syndrome (PUBS), an uncommon phenomenon that turns urine tubes or bags purple or blue, can be encountered in long-term-care facilities. A thorough literature review shows that East Asia has a high incidence of PUBS. It is important to recognize the clinical features and risk factors of this phenomenon. The aim of this study is to explore the characteristics of patients with PUBS and correlate the onset of PUBS symptoms with risk factors. Materials and Methods: We reported nine cases of clinically confirmed PUBS between January 2009 and June 2013. Pertinent clinical information was collected, including age, feeding type, renal function, type of Foley catheter, urine analysis, and bacteriological data. Results: All of patients with PUBS presented with stable vital signs without evidence of clinical infection, such as fever or chills. The mean age of the patients was 86.6 ± 10.1 years, with a preponderance of females (77%). Five PUBS patients (55%) had a history of chronic renal insufficiency. Six patients (66%) had constipation. A logistic regression univariate analysis demonstrated a statistically significant urine pH in patients with PUBS [odds ratio (OR), 3.078; P = 0.036]. Risk factors, such as gender, were found to be significant using logistic regression multivariate analysis (OR, 0.031; P = 0.021). During the follow-up, all of the patients had Foley catheters re-inserted, and all of the patients received health education. Conclusion: The incidence of PUBS in the elderly population is associated with asymptomatic bacteriuria, urine pH, and gender but not renal function, type of feeding, or type of Foley catheter used. To understand PUBS and maintain urological hygiene, it is important to educate families and health care workers about PUBS and to recognize that PUBS is not regarded as a symptom of severe disease.

Increased intrarenal expression of sodium-dicarboxylate cotransporter-1 in nephrolithiasis patients with acidic urine pH.

Background: Low urinary excretion of citrate is a major risk in Thai kidney stone patients. Reabsorption of citrate at renal proximal tubules requires sodium-dicarboxylate cotransporter-1 (NaDC-1). Objectives: We investigated the expression of NaDC-1 in stone-containing kidneys and evaluated the association of NaDC-1 expression with urine pH. Expression of NaDC-1 protein in acid-treated human proximal renal cells (HK-2 cells) was also studied. Methods: Twenty-four patients with nephrolithiasis aged 50.61 ± 13.30 years (9 males, 15 females) were recruited. Twenty-four hours urine samples were collected from all patients. Expression of NaDC-1 in renal tissues and HK-2 cells was determined by immunohistochemistry and Western blotting, respectively. Results: NaDC-1 was expressed mainly in proximal renal tubular cells. Tubular cells in the medullary region were weakly positive for NaDC-1. The intensity of NaDC-1 expression varied among nephrolithic renal tissues and was categorized into weak (6/24, 25%), intermediate (10/24, 42%), and high (8/24, 33%) expression. A trend of decreased urine pH in patients with increased NaDC-1 expression was observed. When the expression of NaDC-1 was recategorized into low (16/24) and high (8/24) expression, patients with high NaDC-1 expression had significantly lower urine pH than those with low NaDC-1 expression. Acid-treated HK-2 cells (pH 6.8) showed significantly higher expression of NaDC-1 compared with the control nontreated cells (pH 7.4). Significant association between urinary citrate and urine pH was not found. Also, significant association between urinarycitrate and intrarenal NaDC-1 expression was not revealed. Conclusion: NaDC-1 was principally expressed in proximal renal tubules of stone-bearing kidneys. High expression of NaDC-1 was associated with low urine pH. To our knowledge, this is the first report of NaDC-1 expression in the kidneys of nephrolithiasis patients. We experimentally confirmed that acid conditions upregulated theexpression of NaDC-1 in the human proximal tubular cells. Keywords: Acidosis, immunohistochemistry, kidney stone, NaDC-1, nephrolithiasis, sodium-dicarboxylate cotransporter-1, urinary citrate, urine pH

Effect of BMI and urinary pH on urolithiasis and its composition

Urolithiasis is a common urological disease predominantly affecting males. The lifetime risk of urolithiasis varies from 1% to 5% in Asia, 5% to 9% in Europe, 10% to 15% in the USA and 20% to 25% in the middle-east; lowest prevalence is reported from Greenland and Japan. Such differences have been explained on the basis of race, diet and climate factors. Furthermore, changing socio-economic conditions have generated changes in the prevalence, incidence and distribution for age, sex and type of lithiasis in terms of both the site and the chemical as well as the physical composition of the calculi. The aim of our study was to determine the association between body mass index (BMI) and urine pH in patients with urolithiasis and the influence of body size, as reflected by the BMI, on the composition. The study was conducted in the Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, on urolithiatic patients. The data included patient's age, sex, BMI, urine pH, serum calcium, serum uric acid, serum creatinine and stone composition. Data from 100 patients, 70 men (70%) and 30 women (30%), were analyzed, with 28 patients having normal weight, 38 patients being overweight and 34 patients being obese. The mean age of the patients was 36.58 ± 9.91 years in group I, 40.47 ± 14.48 years in group II and 37.85 ± 12.46 years in group III (P > 0.05). The stone composition was calcium oxalate (CaOx) in 66 patients, calcium phosphate (CaP) in 60 patients, uric acid (UA) in 38 patients, combined calcium oxalate and calcium phosphate in 28 patients and three stones in 10 patients. The urinary pH levels (mean ± SD) were 7.78 ± 1.49 in group I, 7.15 ± 1.11 in group II and 6.29 ± 1.14 in group III patients (P = 0.0001). Urine pH showed a stepwise decrease with increasing BMI (inverse correlation). Urine pH is inversely related to BMI among patients with urolithiasis, as is the occurrence of urate, calcium oxalate and calcium phosphate stones. Similarly, the serum creatinine increased as the BMI and number of stones increased among the study population.

A Comparison of Oral and Intravenous Sodium Bicarbonate on Urinary pH in Patients at Risk of Contrast-induced Nephropathy: A Pilot Study

276 This abstract has been withdrawn. 277 AComparison ofOral and Intravenous SodiumBicarbonate on Urinary pH in Patients at Risk of Contrast-induced Nephropathy: A Pilot Study P. To, F. Chahadi ∗, M. Freeman, M. Pan, O. Farouque, P. Mount Austin Health, Australia Aim: Intravenous sodiumbicarbonate infusionhasbeen shown to reduce the risk of contrast-induced nephropathy (CIN). We sought to determine whether oral sodium bicarbonate has a similar effect onurinepH to intravenous sodium bicarbonate in patients at risk of CIN. Methods:Cardiology and renal patients scheduled for a non-urgent contrast enhanced procedure and who were eligible for intravenous bicarbonate administration per Austin health guidelines to prevent CIN were invited to participate. Participants received intravenous bicarbonate (150mmole) at 3mmol/kg/h one hour prior, then 1mmol/kg/h during and after the procedure. Participants returned to the hospital three weeks post procedure for o 8 p a h

Association of body mass index and urine pH in patients with urolithiasis

Increase in body size increases the risk of renal stone formation. The mechanism explaining this relationship remains unclear. Urine pH is one of the important factors for urinary stone formation. The purpose of this study was to determine whether there is an association between urine pH and body mass index (BMI) in patients with urolithiasis. Medical charts review that included 342 urinary stone formers (248 men and 94 women). Data obtained included patient sex, age, BMI, urine pH at diagnosis, and stone composition. The patients were classified as normal weight (18.5 <or= BMI < 24), overweight (24 <or= BMI < 27), or obese (BMI >or= 27). The mean urine pH of the normal body weight, overweight, and obese groups was 6.25, 6.14, and 6.00, respectively (P < 0.05). Urine pH is inversely related to BMI among patients with urolithiasis. Among patients with urolithiasis, higher BMI will have lower urine pH. This may explain why obesity is associated with an increased risk of nephrolithiasis. Weight loss should be explored as a potential treatment to prevent kidney stone formation. The prevention of urinary stone disease gives clinicians an additional reason to encourage weight reduction through diet.

Acetazolamide Is an Effective Adjunct for Urinary Alkalization in Patients With Uric Acid and Cystine Stone Formation Recalcitrant to Potassium Citrate

Acetazolamide has been proposed as a treatment adjunct for patients with cystine and uric acid stone formation recalcitrant to standard alkalization therapy. We evaluated the effect of acetazolamide in urinary alkalization in patients with uric acid and cystine stone formation recalcitrant to potassium citrate alone. An institutional review board-approved, retrospective chart review identified 12 patients at 2 sites who had been prescribed acetazolamide as a treatment adjunct to potassium citrate for uric acid or cystine stones from 1997 to 2007. We evaluated the urine studies, metabolic evaluations, surgical interventions, and stone recurrence or growth. The mean follow-up was 46.1 months (range 11-86). Ten patients (83%) were categorized as compliant. Of the 2 patients excluded from the study, 1 was noncompliant with the medication, and the other was lost to follow-up. Of the 10 patients who were compliant with the treatment, 5 (50%) developed adverse effects from the medication requiring discontinuation. Of the remaining 5 patients (50%) who tolerated the medication and remained compliant, 3 (60%) were stone free at a mean follow-up of 42 months. Two patients continued to form stones, including one who developed calcification of an existing uric acid stone. Both patients required surgical intervention. The mean urinary pH before treatment was 5.9 (range 5-7) and after treatment was 7.2 (range 6.5-8.5; P = .001). Acetazolamide was effective in increasing the urinary pH in patients with uric acid and cystine stone formation who were already taking potassium citrate. Caution must be taken when prescribing acetazolamide, because it could be poorly tolerated and can induce calcium phosphate stone formation.